29
CHAPTER 2 Clinical Judgment
Explore Your Nursing Role (continued)
assessment and notifies the hospitalist. Mr.Anderson is transferred to the intensive care unit (ICU) with a diagno- sis of shock from abdominal bleeding. As Jan completes her documentation, she wonders, “Lisa has been a nurse for 10 years—how did she know something was wrong? Should I be a nurse? Did I miss anything? What went wrong?” You will be asked to apply full-spectrum thinking to Jan’s case throughout the chapter as you learn the major concepts associated with the devel- opment of clinical judgment.
2400: Mr. Anderson appears lethargic. States that he is on his boat fishing and asks if I see the fish he has caught. VSS: BP 138/68, P 102, R 24,T 100. Skin cool, moist.Abdominal dress- ing dry and intact.The surgeon notified of client’s confusion. Pre- scriptions received for pain medication and hourly vital signs. He explains that Mr. Anderson is experiencing sundowning, which is late-evening or late-night confusion in clients with dementia. —Jan Watsone, RN Feeling uncomfortable, Jan discusses Mr.Anderson with the charge nurse, Lisa, who immediately conducts an
Theoretical Knowledge knowing why
KEY CONCEPTS Keep the key concepts in mind as you read this chapter. They will give you the “hooks” on which you can “hang” the other details in the chapter. As you gain an understanding of clinical judgment, critical reasoning, critical thinking, nursing knowledge, and the nursing process, you will begin to see how they all work together in full-spectrum nursing. WHAT DOES NURSING INVOLVE? Chapter 1 introduced you to nursing roles, respon- sibilities, and activities and to the profession of nursing. Throughout this text, you will learn that nurses need to have technical skills; a sound knowledge base; and skills in therapeutic commu- nication, critical thinking, and critical reasoning to develop sound clinical judgment. Much of nursing emphasis is on thinking, which is the foundation of being activity oriented (doing) , and now more than ever, the importance of caring. So, another way to describe nursing is to say that nursing involves think- ing, doing, and caring. Thus, your view of the essen- tial roles nurses have in the care of their clients will expand as you progress in your studies. To track your progress, you can later compare your developing view with the baseline you will establish in the exer- cises in this chapter. Think Like a Nurse 2-1: Clinical Judgment in Action What are your thoughts about Jan as a nurse? What strengths do you see, and in which areas, if any, is improvement needed?
Nursing practice has increased in complexity as a result of sicker clients, shortened hospital stays, and increas- ing demands. This requires that in the context of mul- tiple responsibilities (e.g., interacting with different healthcare providers; administering numerous medica- tions; performing various treatments; documenting in the electronic health record; admitting, transferring, and discharging clients; addressing client and family issues and concerns), you will need to multitask, prioritize, delegate, and make decisions to safely address client care needs (Manetti, 2019). As a new nurse, you must use sound clinical judgment to ensure safe client care and outcomes. WHAT IS CLINICAL JUDGMENT? Common factors in definitions of clinical judgment are processes that promote safe client care decisions and outcomes. ■ The National Council of State Boards of Nursing (NCSBN, 2019) acknowledges that clinical judgment integrates critical thinking and decision making. Nurses must apply nursing knowledge “to observe and access presenting situations, identify a prioritized client concern, and generate the best possible evi- dence-based solutions in order to deliver safe client care” (p. 2). ■ Tanner (2006) defines clinical judgment as the “interpre- tation or conclusion about a patient’s needs, concerns, or health problems, and/or the decision to take action
12
Powered by FlippingBook